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Episode 140: Dr. Phil Hellman (He/Him) of Paradox Health DPC - Rochester Hills, MI

Direct Primary Care Doctor

Dr. Phil Hellman of Paradox Health DPC - Rochester Hills, MI
Dr. Phil Hellman

Dr. Philip Hellman is a family medicine physician in Rochester Hills, Michigan. He had no family in medicine, but for him, the path to becoming a physician made the most sense. He went on to Grand Valley State for his bachelor’s and then followed with the MSU College of Human Medicine to attain his MD. He did his residency in Greeley, Colorado at North Colorado Family Medicine. His training there was excellent and is owed in large part to an exceptional group of mentors and faculty on staff there.

With his wife, Dr. Hellman relocated to Silverton, Oregon for his first job out of residency in the Summer of 2016. Although they cherished their time there, they made the tough decision a year later to move back to their family in Michigan where they felt they were being called. That year and a half of work in the healthcare industrial complex opened his eyes even further to the deficiencies of modern healthcare. Its clunky, bloated, and mis-incentivized structure was not something that excited him. He always felt terrible when a patient would get a large medical bill despite paying large insurance premiums or was told the most effective therapy for their malady was not an option.

In March of 2018, he decided to form Paradox Health and start taking part in the DPC model of health care. It is something he thought about since his first year of medical school, and ultimately what he had always wanted to do. It just took the right prodding, and the right people to tell him he wasn’t crazy.

He currently resides in Rochester with his wife Chelsea and their four children: Merritt, Luella, Hattie, and Hannon.


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Address: 455 South Livernois Road Suite C-22, Rochester Hills, MI 48307

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Telephone Number: (248) 949-2224

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Direct Primary care is an innovative alternative path to insurance-driven healthcare. Typically, a patient pays their doctor a low monthly membership and in return builds a lasting relationship with their doctor and has their doctor available at their fingertips. Welcome to the My D P C story podcast, where each week you will hear the ever so relatable stories shared by physicians who have chosen.

To practice medicine in their individual communities through the direct primary care model. I'm your host, Marielle conception family physician, D P C, owner, and former fee for service. Doctor, I hope you enjoy today's episode and come away feeling inspired about the future of patient care direct primary care.

For me, D P C is the architecture that enables me to practice medicine, how I've always wanted to. Hi, I'm Dr. Phil Helman with Paradox Health, and this is my D P C story.

Dr. Phil Hellman is a family medicine physician in Rochester Hills, Michigan. He had no family in medicine, but for him, the path to becoming a physician made the most sense. He went on to Grand Valley State for his bachelor's and then followed with the M SS U College of Human Medicine. To attain his md, he did his residency in Greeley, Colorado at North Colorado Family Medicine.

His training there was excellent and is owed in large part to an exceptional group of mentors and faculty on staff there with his wife. Dr. Helman relocated to Silverton, Oregon for his first job out of residency in the summer of 2016. Although they cherished their time there, they made the tough decision a year later to move back to their family in Michigan.

Where they felt they were being called. That year and a half of work in the healthcare industrial complex opened his eyes even further to the deficiencies of modern healthcare. Its clunky, bloated, and mis incentivized structure was not something that excited him. He always felt terrible when a patient would get a large medical bill despite paying large insurance premiums.

Or was told the most effective therapy for their melody was not an option. In March of 2018, he decided to form Paradox Health and started taking part in the D P C model of healthcare. It is something he thought about since first year of medical school and ultimately what he had always wanted to do. It just took the right prodding and the right people to tell him.

He wasn't crazy. He currently resides in Rochester with his wife Chelsea, and their four children. Merrit, Luella, Hattie, and Hannon.

Welcome to the podcast, Dr. Hellman. Hey, nice to see you, Marielle. So, I will say back at the level three track of the D p C summit this summer, Dr. Hellman was doing a, a presentation on Lipidology and I, I went up to him afterwards and I was like, are you a cardiologist doing direct care? He is like, no, I'm a family practice doc.

And I was like, oh my gosh. So this is an example of how, you know, I, that's because I failed to introduce myself to the whole group. That is one way to think about it. The way that I think about it is that you have the time because you, that you, that you have an interest and you have a desire to know more on, in this case lipidology, and you have the time to do whatever research you need to do to be able then to take that research to fellow physicians as well as your patients and give them the most up to date.

Information and it sure as heck has affected my practice. So like, you know, you having the time to do that is woven in into your story, which we will obviously get to. But you know, I wanted to, I just wanted to mention that because it is so important that as people listen to these podcasts, you, you hear how time.

Manifest in people's lives. But I just wanted to really shout out there that I'm grateful that the time you have had, um, has allowed a talk on lipidology and you're, you know, delving into that. So, with that, let's get started by, you know, I was really inspired on your website when you said that you didn't come from a family where everybody was doctors.

But you really got inspired to, you know, get involved with knowing more about the human body and about medicine when you were in high school. So let's start off with telling us more about what happened in high school that started your journey in medicine.

Yeah, so I think like most high schoolers, I didn't know what I wanted to do, so I sort of worked backwards and would just, I kind of knew what I didn't wanna do.

And then along the way I had a few positive experiences that kind of pointed me in the right direction. So I was, in general, the whole idea of business, just, I had no idea what that meant and I had kind of a negative connotation with it. And so I thought, well, I'm not doing that and now I own my own practice and, and I took high school anatomy and I really, it just came easy to me.

Uh, so I thought, okay, maybe something in healthcare, biology, that kind of thing. And then I also went on a couple of mission trips in high school, and I really enjoyed those experiences because a lot of them involved just directly helping people. So just that kind of hands-on, being able to have relationships with people and help them in a more direct way rather than in a lot of places where you're kind of helping people indirectly, which I now appreciate but didn't at the time.

I, I kind of thought I, I'd really like to do something where I'm kind of more hands-on directly helping people and, and so that kinda led me down the healthcare path.

That's awesome. And I will put out there, you know, I was just talking to my cousin Jackson, who is, he's in college, but he was talking to me about how he had this non-healthcare related experience in, uh, in doing research in Hawaii this summer.

And he's like, well, you know, I, I know I wanna go into healthcare, but it's not really healthcare related. And I'm like, Do not sell yourself short, because every single experience we have, like for you, it's like at the time you thought you like business. That's awesome that you are a thriving business owner now, but you know, you have these experience with what is directly helping someone versus indirectly, and it does not have to be in medicine, but don't sell yourself short.

In terms of all, all experiences that we have going into becoming doctors, going into becoming D P C physicians. It really matters. And for you, you then jumped into like once you were, you graduated from medical school, you went to Greeley and My husband and I had looked at the Greeley program, Greeley, Colorado, because it was one of the, you know, we looked at full scope family medicine, unopposed programs, and Greeley, you know, exemplifies What does it mean to have a full scope family medicine training.

So tell us about your experience in Greeley. And tell us about, especially the people that you studied under, the people who trained you to be thinking and learning like Dr. Hellman does today.

Yeah, Greeley was, was phenomenal. I mean, I, I could tell jokes about it because I had, I had applied to some other programs in that same state and had a friend who lived in, um, golden, my buddy who lived in Golden.

I had, I had interviewed in Greeley and I had interviewed at some programs in Denver, and he was like, Shoot, man, you better interview. Well in Denver. 'cause you don't want to go to Greeley. And so it's kind of known as like the town in Colorado, that's like the ugly stepchild, but it's also one of those towns where when you go there, at first you're like, I can't wait to move.

I. But then after you're there for a couple of years, you really fall in love with it and you're like, this is actually a great place. So like you said, the training there is definitely full scope. It's about a 350 bed hospital, north Colorado Medical Center. You know the only other program there is podiatry.

And if you want to, you can train in surgical ob and you can also get training in scopes. So egs and colonoscopies, and I did both of those things, you know, and in large part, I think a residency program is all about the experience, right? And, and the experience provided by. The type of hospital you're at, the location you're at, which kind of determines the patients that you see, and then the diseases that you see.

And then it's also about the people that are training you, right? Because they're really responsible for your education and keeping you in line and, and making sure that you're prepared when you leave. And so we just had some excellent faculty that, you know, themselves were full scope docs and you know, one in particular.

Had practiced, you know, independently in Kansas for like 20 years and he just had all these crazy stories. He had delivered like 5,000 babies and he was actually, hi out of him and all the obs that had privileges at the hospital. He was the only one privileged to use forceps because nobody else basically had used them.

Yeah. And he was just happened to grow up in the time when that was sort of trained. And so I. We actually used forceps a handful of times during my residency program, which I think even most obs never touched them. So it was, it was really great and then I continued doing that when I left, when I left residency, I, I, I kind of kept up all those skills.

That's awesome. So when you were then going from residency into finishing residency looking for, what do I do next? Did you always seek to find an employed position or did you seek to do an independent practice given that your initial high school self was like, I'm not a business person?

Uh, yeah, I didn't have a, I didn't really have a preference.

It was really just about the total, like my first two boxes were really location and privileges. Right. So for all the residents and students listening, obviously. Privileges for a family doc is, can often be harder than if you're a specialist. And so especially for OB and for scopes, you generally have to be in a more rural area if you wanna be doing C-sections and scopes.

And so, you know, you're kind of limited as to where you can go. In a lot of the places that I interviewed at, you know, simply put, it's not great for a spouse to to be there. And so it's one of those things like, oh, I would love to be there, but you know, my wife would be pretty miserable. So we gotta kind of find a place that's, that's manageable.

And the practice that I joined in Silverton, Oregon just kind of fit that bill. So we wanted to stay out west and still kind of like be in the mountains. 'cause we really loved. Everything that, that had to offer us. But the pay basically, frankly, in Oregon was like 30% more than anything I could get in Colorado.

Uh, so it really felt kind of like there was a sunshine tax starting there where, I mean, it didn't matter where I worked or how much I worked like did not pay well, it was like below national average, even with. And scopes. And so I was like, I just we're gonna have to go somewhere else. So I ended up finding that job in, in, in Silverton.

And it was with a group practice, it was a private group practice. Uh, I was actually paid like an employee, but you know, sort of treated more like an autonomous physician.

That's great. And. You know, it speaks to my heart in terms of when you wanna maintain full scope family medicine, you know, going to a rural community, that's exactly what, you know, I wanted to do scopes and I wanted to make sure that I could do ob, I don't do deliveries, but to even just, you know, see people for prenatal care.

It was very, very difficult in California, even back in 2015 to find places where I could do that. And so, you know, it speaks to my heart that what you were looking for was. To keep being the doctor that you had trained to be. Yeah. And to be, be able to do the things that you have the skills to do. So when you were looking though, how did you find the Silverton group?

Because for those people who are not necessarily thinking like, I'm full bore D p C, but I'm interested in doing, you know, a practice, I'm, I'm join, interested in joining a practice where I would be able to maintain my skills. How did you even find that group? Because. It's not always, you know, sometimes it's serendipitous, sometimes it's word of mouth.

But how did you come to find that independent group and are they still an independent group? As of today, the guy that owned the practice, he was a guy named Rodney Orr. He had gone to my residency program way back in the day. He was like, I wanna say one of the first guys out. And he emailed the program director and said, Hey, we're looking for another doctor.

You know, are any of your, um, upcoming graduates interested? And so our program director would always forward, he would just blast those emails out to everybody. We were constantly getting emails about different job opportunities. And so I. I think I was like the only one who followed up on that one.

And you know, there's a, there's a golden tip if you're looking to grow your D P C, especially if you're already practicing and you want physicians to come in, whether you want a physician who does pediatrics and you don't, or you want, like in your case, um, Dr. Davenport, who's your partner is internal medicine, where your family. If there's different specialties even that you want to come in, that is a great way to engage with residencies. I, I got an email that was shared with me from my old residency where a particular fee for service job was looking for a program director for a residency that they've already accepted residency without a program director.

They have an interim like assistant program director, whatever, but it was like the emails that they get. Can you imagine if a program director read like, Hey, you know, like here's a fee for service job where, you know, they're very pro D P C, they're very pro protecting the physician's autonomy. And they're like, but I also have this D P C offer that came in.

So like, In the email, you know, you can take a look at all these job offerings, but like this would be a great one to look into. And so I think that program directors are not blind. I get that a lot of programs are in, you know, the Kaiser system, the fee for service system, but when it comes to program directors really fighting for their students and their residents, I really think that program directors in general have a really good sense about.

You would be a great fit because you love all the things. You love, dermatology, you love, whatever, and sending an email just like how it affected your life. Not to say that it was the best 'cause obviously you, you moved back to Michigan and you changed and you went D P C. But just in terms of using that as an opportunity to get the word out there about your D P C practice, it's definitely something to consider.

So going back to your journey in Silverton, You were introduced to the Silverton practice by somebody who had understood what it meant to be a full scope family physician from your residency. What happened in Silverton that made you come back to Michigan?

There was a lot that happened, so right. See about a month into moving there, one of our family members came down with recurrence of kidney cancer, renal cell carcinoma.

So it was some small metastases to the lung. And knowing what I know now, that's actually not the worst thing in the world. But at the time I was like, oh my gosh, she is stage four renal cell cancer. This is insane. So that was super stressful 'cause it was actually my wife's dad and then they didn't want me to tell her because she was already really just in a tough spot.

We had just had our first child and uh, went through some things with like breastfeeding issues and weight loss. She was super stressed out, no sleep. And then, yeah, so it was, it was one of the most stressful times in my life. So we kind of make it through that. And then I'd say, you know, two more things happened.

One, there was, there was kind of discontent within the group. And so there were some physicians that actually had decided to leave the group and start their own practice and split off. And they're still practicing. They, you know, they're still independent. There's, I believe, Two or three docs and a nurse practitioner.

And then the old clinic, the, uh, the guy that owned it that had sort of recruited me started practicing again. And then they've subsequently sold to Legacy, which is the hospital that had just bought the Silverton Hospital. So they're now sold off. Uh, to answer your question from earlier now, we, my wife and I ultimately decided to leave because she became pregnant with our second child, and we kind of looked at each other and we're like, Every time our parents come out here to see us, it's just rough.

You know? They kind of like leave crying and wanting to see us more. It's not an easy flight. It's a three hour time difference. Colorado was a lot easier. Two hours for whatever reason, is a lot easier than three. And all of our entire family lived in Michigan and none of them were really able to move.

All their jobs were pretty, you know, set in stone in that state. So we were kind of like, look, we, we moved out here to be in the mountains, but when we never go, like we have a kid now and all we do is hang out in town and hang out with our friends. And we're like, we can do that in Michigan too, and we'll have our, all of our family.

So I think it's time to go back. And that was just after a year and a half. Now, the story I want to tell because it's one of the best D P C stories. I don't know. Have you had Robbo on in Yes, indeed. December of 21.

So I don't know if he, he might've told this story, but I was sort of, so he, he was in that group that I initially, that I worked with in Silverton and he, he had already been thinking of leaving the group to do D P C and the straw that broke the camel's back for him was me, because little did I know, but the practice manager did not tell the other doctors that, they didn't tell them when I was coming, I.

And they also didn't inform them. They were putting my desk in their room, which was already this kind of small office with four desks in it. Wow. For four providers. So I was the fifth provider in like a single office, and everything was just so crammed and they gave me the window. And he was just like, that's it, you know, like, I'm done.

And so he, he said that was literally the moment where he is like, I'm outta here. And so he started planning his practice and stuff. And then, you know, Rob and I ended up becoming good friends and he's one of the first people I called when I moved back to Michigan and was considering, uh, starting a D P C practice.

And I was like, Hey, should I do it now or should I wait a year or two, you know? Take a, you know, kind of standard family job. And he's like, no. He's like, do it yesterday. It's the best thing you'll ever do. So anyways, just a great story. And he's got, I think, the biggest patient panel of any DPC doc. I know.

Yeah. Hands down. I mean, it's like, I think he said over a thousand, if I'm remembering correctly. Yeah. Now he's got a, he's got a nurse practitioner helping him out now. But bef, even before that, he was at like 8 59. I was like, how doing this.

Awesome guy, full of energy, definitely take a listen to his episode.

Um, but it was the second to last episode of the first season of my D p C story, so absolutely. But I don't think that he mentioned that the office situation and the window specifically, I have to go back and listen to it myself. But that is awesome that we're connecting those dots. And now, I mean, you opened 2018, you opened Paradox DPC 2018, and then you've been off and running and now Dr. Davenport's with you, but. I think that's awesome. Let me just go back to your experience in Greeley because you, um, excuse me, in, uh, in Silverton, because you didn't have the job, you know, like you're saying, the just take a family medicine job and then open your D P C. When you were in this fee for service job, something that you had written about, and I'm wondering if this came from your, um, experience in Silverton or if this came from the experience in Greeley.

Was that you, you had mentioned in your bio on your website about how it was. Crushing to you when people would come to you with huge bills like that wasn't your intention to put people into bankruptcy for paying Yeah. For their medical care. So I wanted to ask, you know, where, where did that statement come from?

Just having, having people throughout that year and a half in Silverton, where you'd order labs on somebody and they'd come back and be like, do you know what those labs cost me? And I'm like, no, I have no idea. Not a clue. And, and how was I supposed to know? Like, I don't know what insurance you have. I don't know what your deductible was.

It's so interesting 'cause we're we're coming off the heels of Dr. James Goor talking about as an emergency medicine physician who's now doing D P C at Halon Health in Irvine, California. How, like the number one thing, and you and I know this because we lived this when we were on rotation in the er, but it's like the number one thing you think about in the ER is where's your face sheet?

What insurance do you have? And it's like, we all know that life, but in primary care, I don't think I ever had the face sheet as the top page. Like in our clinic and fee for service, it was like the demographics, like who, who the patient is, what's their chief complaint type of thing. But it wasn't like a full face sheet with like, here's this and here's that and.

In no class in medical school are we taught, like if they have a BUCA plan that means their coverage for blah blah. 'cause there is no transparency. I mean, we're working towards it. Great. But like as you and I can say, like on your website, you know, cholesterol, whatever is like $4 to check it, you know, you can't do that.

You can't know those things necessarily coming off from the curriculum that we get in medical

school. Can I tell you kind of a crazy story about this? Please? Just happened to me personally. I kind of like, I actually wanna write an article about it. So my family and I have a health share plan. Yeah. And.

Uh, it's Liberty Health Share is what we have right now, and my daughter was having some episodes of vomiting and headache. She's five and she had like four episodes in a six month time period and they were getting more frequent and so I thought she deserves to get a, a head. M r I. And as far as I knew, there were only two places I could get one of those, you know, for a child, because you have to have a special like pediatric certificate for outpatient imaging of, uh, pediatrics.

And my normal imaging center didn't have one and I just kind of assumed the other ones didn't either. So I was going through Children's Hospital of Michigan and system called Beaumont, or what's now Corwell Health, but they're, those are the two big, like pediatric systems in the area. And they both can do sedation for M R I.

Right? 'cause one of the big issues is kids might move around and can't stay still for 20 minutes. Alright? So both of them tell me that I can't write an order for my daughter. And we, we had talked to somebody who works at Beaumont and she said that that kind of just went into place like a year ago. And one person from Beaumont tried to tell me that.

It was against the Stark Laws for me to do that. And I was like, that's awesome. What a Stark Law is like I don't have an investment in the hospital or the M R I machine or like what? So anyways, and they kind of treat you like you're a criminal when you do this. Right? Like I had the one lady from Children's call me, she was a doctor, I think she was a radiologist, and she said, our risk management team won't allow us to.

To fulfill this order, you, you need to get another doctor to, so long story short, we go, we agree to see P'S Neurology at Children's Hospital, which I thought, okay, that's fine. You know, and, and who knows? Maybe they'll tell us. We don't even need the M R I and we can save the money. He agrees. We need the M R I.

At the end of the appointment, I tell them we're cash pay. And they say, okay, the cash pay rate's $479. I think, okay, for a hospital for an M R I, that's actually pretty reasonable and I'm fine with that. And if she needs sedation, they can give it to her. So we know we're gonna get the study we need no matter what.

Well, I then kind of tell the lady, I'm like, well, we are cash pay, but we do have this health share plan and. They had actually recently sent out an email that said, we have a new vendor and we now can bill directly for a lot of things. So I called Liberty Health Share. I told them what was happening and said, would you like to try to build them directly?

And they said, oh, definitely they're part of this new network, this vendor, I think it was like P H C S or something. And then I call Children's and I give them the information and they're like, okay, great. Yeah, we can, we can take that vendor, we can build 'em directly. The cost is now gonna be $5,000.

Amazing. Upfront, right? Because they have a policy that for anybody with my type of coverage, they want payment upfront and they want to bill you the maximum amount of your, what is essentially your deductible, but what the health shares call, like your initial unshared amount or whatever. So they're gonna bill me whatever my initial unshared amount is to the max.

So I try to fight this a little bit and I kind of take it up the chain and I end up talking to somebody who's like manager, and the manager comes back and just says, I'm so sorry, but this is our policy and the, the price is gonna be $5,500. So as I tried to fight it and I had a bunch of people along the way say like, this is crazy.

We, we, we should be able to take care of you. Like, uh, you talk to my manager, the price goes up.

Like, oh my God. It's like an elevator Next. Next level up, next price up. Oh my God. It was insane.

And so I'm like, okay, so you guys are just cool with the Europeans neurologist saying she needs an M R I, but me not getting one.

'cause who has $5,500 to just shell out for an m R mri? Nobody, you know, I'm like, you see Medicaid patients all day long and don't charge 'em a dime. And you want, you want me to make. You know, I don't know, $5,500 used to buy a car back in the nineties. So anyways, we ended up getting one through an outpatient imaging center called R M I that does have the pediatric certificate, but they couldn't do sedation.

And luckily my daughter stayed still through the whole thing and it cost us $330. Long story, but I mean, it's crazy. Yeah, I was just gonna say that kind of, you know, that explains the whole idea of these, you know, uh, ninja Bills and, you know, people not knowing what they're gonna have to pay for stuff.

And makes me think of new Hoff's, uh, Ryan, new Hoff's article on, uh, green Cross Green Shield, your grocery insurance.

Absolutely. And you know, when you talk about, Lack of transparency, fraud when it just keeps going up. The more people you talk to, you said something in, there's a separate video on your website where you're talking to potential patients.

You're like, Hey, this is what we do. If this is a good fit for you, um, let me know. But one of the things you've said in there is that you're somebody's guide in the jungle, and that is real man. That is so real that like, You and I have these conversations, I'm sure on the daily where it's like, yes, you could pay for your lisinopril through your insurance or your M R I or your calcium score.

However, the calcium score is not covered by the insurance or the lisinopril. You can actually get for a year for less than the same price that you're paying through your P B M or whatever. But it's like I was never, I don't know about you, but it's like I, I was never able to say these things. Had I not, you know, been able to log into my, you know, wholesale website and be like, the current cost of euro lisinopril is like pennies on the dollar compared to what you're paying now.

Or would you like to see the menu of cash pay pricing at our local radiology center? I have that saved on my phone as an, as a graphic so that I can easily like, I mean, people. Like I picked up free, uh, what is it? Cubicle panels in Sacramento one day and the dude was, you know, talking, oh, you're a doctor, blah, blah.

I'm like, oh, you need an M r I for your knee. Well, the price is this. If you go to Modesto and do this. And he is like, how did you know that? I'm like, because I work in cash, I work in transparency. And so when it comes to people who have understood paradox, What are some of the things that you hear? 'cause there is a montage for those people who have not been to Paradox DPCs website.

There's a montage that you guys have of your patients. But one of the things they talk in there about is, you know that health insurance, there's one patient in particular who said, I'm really understanding that health insurance is not healthcare. So, When you have patients coming into the practice, like what are some of the things that you're hearing from them that paradox, d p c is, is helping with or saving them from because you guys exist.

Yeah, so back to, to the, the health insurance is not healthcare comment. It, you know, it's kind of a, a cliche sort of in a way, but it's super true in that, you know, especially for that particular patient, he had health insurance and then I. His family member went through a whole bunch of stuff where she needed a ton of healthcare and they were just getting bills constantly.

And so what he realized was, this insurance doesn't really buy me anything. You know, it might kind of protect, protect my family members from dying, but if they actually need help when they're not well, I'm gonna have to pay for all that out of pocket, you know? So I have to essentially pay, in addition for my healthcare, Which is the actual care that you, that you're receiving.

And so that's that comment, you know? And I think a lot of people, a lot of people come to D P C for that reason. I have some other friends that, you know, told me stories about going to the ER and you know, nothing happened in the er. And then they were admitted and they got a bill for the ER visit for $3,000 and they're like, called up the hospital.

They're like, you did nothing. What's the $3,000 for? And so they get fed up with it and they're like, I want a different, And, and frankly that's kind of like the big reason why I started D P C 'cause I was having these conversations with people and I thought, these people aren't just complaining about their healthcare.

They're looking for an alternative option. You know? So I think what Paradox Health can help a lot of people with, it's just kind of the classic, you know, three legs of the stool D P C thing, which is. It's the only solution that can simultaneously solve the problems of quality, access and cost. You know, so I think that we do that pretty well.

I always kind of, when I started this, I didn't want to have just a kind of quick visit clinic, you know, for a low monthly membership fee. I wanted to provide the highest possible level of care for still an affordable price, and I, I still think it's super doable.

I love it. I wanna ask you about your, your founding days at, at Paradox Health.

But I wanna ask one thing, uh, as I mentioned these videos, one of the things that I loved, uh, at the, uh, solo video that you did, at the end of it, you said, you know, you wanna know more. Go to my website or simply pick up the phone and dial this number. So, you know, in terms of engaging patients who are potential patients who've never met you before, what was the reason that you said, you know, just pick up the phone and call versus.

Go through the website. What was the intention there?

Well, when I made that video, that would've forwarded to me, you know, but I, I definitely, you know, you're much more able to explain D P C over the phone than you are via website. I think that's one of the biggest problems that we have as explaining what is direct primary care.

I think it's a simple idea, but it's so different. People have a hard time understanding that it's real. And they always have additional questions or they think that there's some kind of a catch or a hook. So that's why I think phone conversation is always easier and it's not like we're getting a hundred phone calls a day.

So it's pretty easy to field those calls. Love it.

And going back now to the opening of Paradox Health. So when you had talked to Rob and he was like, Dude, just, just open from day one. Don't, don't waste your time doing other things. Just put all eggs in the basket and open your D P C. How did you go from Silverton to opening?

Did you move to Michigan first, take some time off and then open, or were you like work in the the, the D P C already from Silverton? No, no.

It was the former, so I just basically moved here. We had some savings. We had sold our house. And we moved right around Christmas time. And so I was like, I'm not in a rush to get a job.

I'm just gonna enjoy my family and hang out. And uh, it was really nice. It was a great time, but then quickly I was like, I need to start working again. So I started doing some locum stuff at Urgent Cares and very quickly realized I didn't wanna keep doing that 'cause that's horrible. And I actually. I had called Rob, and then I also met with Paul Thomas down in Detroit who started Plum Health and we met for lunch.

And after that conversation I was more so, you know, kind of convinced that I should do it and had a much better understanding of what it took to start up. You know, that's always kind. The question that people have is, well, how do I do this? And it's really not that hard. So going from this place of, you know, experience and being a, a successful D p C entrepreneur, I want to toss in there a statement that you had made, um, also in your bio that you know, you talking about giving care directly versus indirectly.

You, you mentioned how in med school you really wanted to, to do this direct care for people, but it took the right prodding and the right people to tell me that you weren't crazy. So when you talk about, you know, meeting with Paul Thomas, meeting with Rob. Mm-hmm. You know, finally coming to this place of like, okay, yeah, I can do this.

What was it that, in addition to just the, the sequence of events, what was it that made you say like, today is the day that I am opening? I don't, I, I mean, I didn't really have a grand opening. I was more so just having conversations with people and letting 'em know what I was doing. And I have a pretty good network here in Michigan, so it really like, I.

I mean, my first day of opening was probably just the day that I got my tax ID back from the federal government. Like that was about it, you know? And then I opened up my business bank account and I was like, okay, I'm open. So I didn't really do this big announcement. I didn't, I never had the Chamber of Commerce come do some grand opening thing.

I mean, I should have, but I didn't. And I started seeing people at home before I had an office. So I was doing some home visits and still doing a ton of work at Urgent Care, and then I eventually started doing some Telemed stuff. But that was kind of, it was just like as soon as I could open I opened, you know?

Love it. And I hope that gives people encouragement in terms of when you're opening like Dr. Hellman's, not mentioning like I, and I get it, like I am totally envious of Dr. Brian Blank's, Ember Modern Medicine in Greenville. It's absolutely ridiculously beautiful. Listen to his episode to hear more about that, but.

I will say that we've talked about this on the podcast so many times, like if you're wanting to open, let that drive you rather than, you know, I can't open until I have this, until I have this. The people want you, the people want a different way of doing healthcare. The people love, like I love, I'm super envious of amazing buildings and clinics.

However, you do not need that to open. Yeah. And I think that, you know, by hearing your words as to like, it wasn't a grand opening, similar in, in, you know, my neck of the woods. I didn't have a ribbon cutting or anything like that other than like buying some ribbon off of Amazon and some big ass scissors.

And the just like taking my kids to the levee and having my tripod like take a picture of me and my husband and my kids and my dog. But it means so much to you as the doctor opening and doing D P C. That's the thing that matters. That's the things that your stories are gonna be around. That's the thing that you're gonna tell your kids and your grandkids about.

So when we talk there about you opening. And I love that you, you know, just did it. You did telemedicine visits first. At what point did you decide to open a physical location?

I'd always wanted one. It was just kind of a matter of finding a spot that I could afford. So I rented a room from a friend who's a chiropractor that was my first office, and I was there for two years.

And it was super cheap, really low overhead and great visibility. It was in a really high end strip mall, you know, so plenty of parking. And I just had one room and I had everything in that one room. So, I mean, and a lot of people do that. I'm not, I'm definitely not the only one who does that. So, you know, and for me, I, I'm not like a huge risk taker.

I already had a ton of student loans. I didn't want to take out a big loan and, you know, rent some massive building and hire a bunch of staff. That's just not really my style. So just started out kind of, kind of slow and, and I think what it also really helps to work the kinks out. You know, if you just start kind of low profile and you see some people and you know, you're printing scripts and you're, you know, you're kind of working through, okay, what are the hiccups?

How do I do this? What are the nuts and bolts of how I'm actually gonna do this? You know, those first 2050 patients are kind of like your beta testers.

Definitely. And when you decided to open and you finally opened your doors, you're doing medicine just about a space initially and then moving into this one room clinic in the chiropractor's office, how did patients find you?

Did you, you know, have all your family tell everybody they knew? Or did you, did you do an open house even with the space you had? How did you get patients in?

I never did an open house. I still think I might at some point, maybe for my 10 year anniversary, I'll do a ribbon cutting. So most of it was just word of mouth at first.

Just telling friends and family, Hey, spread the word, and that kind of thing. Had some stock cards made up. Went around to some businesses, had some co, actually had some really good conversations with businesses at first, and then the thing that really helped was joining. I joined A B N I group. For those that don't know business Networking International, it's kind of this cliche taboo group that people join that's really kind of corny.

You get up and you do a presentation for 30 seconds. The beginning of every meeting, it's once a week, but it was great and I met some awesome people. So a lot of it, I think it just depends upon the group that you get in with. But I'm still friends with a. Even though I'm not doing it anymore. And at one point 10% of my patients were direct result from that B N I group.

Wow. Which is huge. You know, you think that's thousands of dollars of income just from that one decision. And you know, the group costs like five, 600 bucks a year to be a part of. And then I was doing the Chamber of Commerce stuff, going to those events, going around, talking to people, got a business outta that.

So I think, you know, and you don't see a direct result from that kind of stuff right away. It's, it's the long game. It's conversations you have with people and then a year later they call you and say, Hey, I saw you at this event a year ago. Thought about calling you, but I never did. But now I am. Yep. And it also just helps to keep you busy because early days of D P C are pretty dejecting.

You're just sitting around doing a whole. And you don't have a lot of patient appointments, you're not doing podcast recordings and uh, you just need something to fill your time with. And it is productive even if you're not getting patients right away. You gotta kind of look at it as like planting the seeds and, and eventually it will pay off.

I loved, you know, 'cause I technically, I was doing podcast recording while I was waiting for patients join practice, but, well, you're smart.

But what I will say is that just. Even, you know, like I will show, throw a big shout out to Dr. Jalen Pritchard, who's also been on the podcast. Um, she's in Spokane, Washington at Thread Health, but she is a perfect example of how, when you have the time, like similar how to we, how we talked about like, you dove deep into lipidology, she delved deep into how do I do D p C?

What are all the questions I have D P C, and I love that because, There's so many resources that we have now, especially compared to when you opened that the, the resources are endless in terms of opinions on how to open, how do you do your overhead, how do you do your p and l? Who do you hire for a coach?

Do you hire a coach? All of these things, like there's all of these resources that are in existence because there's more and more of us out there who have stories and have stories that have been shared. So I think that, you know, as you're sitting there, Patients planning for those patients to come. It's, it's definitely a time that I miss sometimes because I'm like, man, I wish I had more hours in the day to do.

X, y, z you know, putting specialists into my EMRs so it's ready to be used for referrals and all these little, little bits there. But, um, it, it's definitely, it, it's something important to hear because if you're expecting, like Dr. Kissy Blackwell, I'm gonna have 2 78 patients on day one. It's like, Awesome.

Go. Go for it. If that's you, you do you. But I, I will say for those people who might not be in that same boat, it's okay. It's okay. Like we are still alive. We are still open, and we are having patients who, like you said, like they, we planted the seeds and then they come later. Like I saw one of those patients yesterday.

She was talking about how. She did not realize how important it is in rural America, in our case, to have access to a physician when you need it. And unfortunately, something had happened with this person's spouse where there was, you know, a need to contact the doctor after hospitalization and there was nobody I.

There was nobody. And so I, I love that as patients find us, it speaks a lot to the patients who understand what we're doing, who want us, and then they become our patients. Those are the people that they might be skeptical, like I think Dr. Emily Scott said one of her first patients was like, am I on candid camera?

Like, is this real? And it's like, yes, this is real. And yes, we are here for you as long as you have openings in your practice. So I say that. Because it, it is, like you said, you know, if, if people are thinking about like, oh, these first days, they might be scary. It's okay. I just wanted to put a, a word of reassurance there.

Yeah. Now, when it came to you, you said that in 2018, like you were open for two years in this chiropractor's office. I. What happened after start of the pandemic, so March of 2020 hits. How did your practice fare in terms of, did your practice grow and that allowed you the income to then go into a space or what?

What did your, what did Paradox Health experience during the pandemic explosion of growth? I'm trying to think about how many patients I had pre pandemic and then post pandemic. What I can say is I was doing some telemedicine still pre pandemic, and then I was actually doing it. They, they had upped the rates that they were paying, so I kept doing it at the beginning of the pandemic, like a ton of it.

And I mean, it was great. I mean, I made a lot of extra money that year from doing that. But then, you know, I think I, I probably stopped doing that stuff towards the end of 2020 because I had so many new patients that had signed up. I was just gonna pull up my report in Atlas and see. 'cause it, it tracks active patients over time.

Yeah. And the reason was we were treating people for covid and nobody was so, I mean, we even had doctors coming to us asking to be treated and, you know, it was just kind of the same, uh, the same line at every other clinic was, you know, stay at home. Good luck. If you can't breathe, go to the hospital. And so we were seeing people, we were closed for the first, like maybe two months of it.

I was still seeing some people in person, had a guy like slice his knee open with an Axe on Easter. So I came in and sewed him up. But I wasn't doing physicals for like, you know, the first two months, two, three months, when everybody was kind of really unsure as to what the heck Covid was. But then once we had a better understanding of it, we opened back up.

And that was it. I mean, we just, like I said, we just exploded with members. I had to close to new patients for a little while because I was so busy treating people for covid and then also seeing my own patients. So February of 2020, I was at 351 patients, and then this would be like February of 2022, I was at 701 patients.

So that's basically doubled my patients in two years.

That's some Rob Rosborough action right there, man. That's crazy. That's crazy. Yeah. So let me ask you there, because you know the word was getting out and especially because you were treating Covid and people were finding you, and then I'm guessing learning more about the practice and then deciding like, I can't not have access to this amazing doctor, you know, whether there's a pandemic go going or not.

But at what point did Dr. Davenport join your practice? Was it during that time to help you, you know, get all those patients onboarded? I met Dr. Davenport towards the end of summer, fall of 21. I remember, 'cause it was like, I play in this like Friday night hockey skate, and it was like the first, the day that I met her was like the first skate of the fall.

So it wa it was like late September, early October of 21 and she ended up joining, I wanna say it was March of 22. That was kind of her timeline for when she could come. Yeah. And then how I met her was she just, she had been interested in D P C for a while and while still is a part-time program director for an internal medicine residency in Pontiac, uh, the McLaren Pontiac internal program.

And she'd just been kind of looking to get out of it. And so she met with actually Paul Thomas or called him. Had a conversation with him, and then Paul directed her to me and said, Hey, if you live, I mean, she happened to live like a mile from from me. He said, Hey, if you live up there, you should just give, you know, Phil Helman a call and, and talk to him.

So, so we met for coffee and you know, hit it off.

That's awesome. I will drop here. I sent a message before the podcast, but I will, I will drop this here the first time and I don't know if she remembers. So when she hears it, she's gonna probably like die laughing. But like I was quickly going down to, I think set up like the my D P C story banner or something at the D P C summit in Kansas City.

And I was like, you know, back to the future sweatshirt and like socks and sandals and she's in her like tank top going to the POCUS workshop and I was like, Hey, like. What's your name? And so she was like, oh, I'm Lindsay Davenport. I was like, awesome. But I was like, you know, it wasn't a big conversation.

It literally was that, but I totally like, this is, this is what happens when I meet people. It's like you, I totally like the first image I have of you is that you the the 3 0 1 session and the first image I have of Lindsay Davenport is like, I don't look like a doctor, but I really am Like it's good times.

But So when you guys connected, and you know, I know that she was wanting to do D P C as you mentioned, but how did the conversations go to bring her into Paradox Health? Well, it wasn't that difficult. She was pretty much said, look, I wanna do D P C, you know, can I join your practice, essentially? And so it was really just a matter of kind of ironing out the contract and, and that sort of thing.

And, and it was very easy because she said, I don't, I don't wanna be a partner. I don't know anything about business. I just wanna see patients. And I said, perfect. 'cause I'm not, you know, struggling with the business aspect of things. We've got tons of patients coming in and I was at that point where I.

If you've been open for five years and you're a male only practice, you get a of patients who say, Hey, you know, I'd really like my wife to join, but she really wants a female. Hey, have you ever considered hiring a female? Yes, I have. It's not as easy as you think. Uh, so yeah, it was perfect. I mean, it would be nice if she could see kids, but I'll take it.

So Awesome. So yeah, it worked out really well. And when she immediately came on as she did, did, did you just have her come on as a 10 99 then? So she was just able to. I mean, she, she probably doesn't care me saying, but she still gets paid as a 10 99.

Well, that's how Dr. James Goor and Dr. Emily Scott do it at, at Halon Health, and they spoke to that on the podcast because like, there's different ways of, of bringing people on.

But I think that from a, how do we get you, you know, your feet wet and you going to see patients and you doing, you know, what you need to do in D P C as soon as possible. I think that's a very reasonable and easy way to do it, relatively speaking. So when she came on, How did you manage your patient panel versus her patient panel?

Because on your website you have the option, like are you looking to see Dr. Helman or are you looking to see Dr. Davenport and then I'm assuming you have different sign-on links, um, on the backend from that, that part of your webpage?

Yeah, well not different sign-on links. It's the same link, but you just click a dropdown box and, and they can click Got it.

Which doctor they want. Uh, it's just the Atlas enrollment form. So at first I was essentially, when she came on, I like closed to new patients and then it, so on the website it said, join Dr. Hellman's wait list or join Dr. Davenport's practice. So I was trying to funnel people towards her mostly just because I was so busy, but also because I wanted to fill her up.

We also had a wait list from Covid, and so we called on that wait list. It was about 60 people. I don't know, maybe a third of them, you know, ended up following through and signing up. So that worked well for a little while. But then, you know, there is attrition in D P C. You know, you have people that drop out for whatever reason.

Uh, I think the number one reason here is people move to Florida as, uh, as funny as that sounds, is pretty true. A lot of people move into Florida, so you do have to replace those patients. And I finally got to a point, I. Maybe six months back where I just said, you know what? I need to open back up. Because I also started finding out about people who had chosen not to join our practice because they really wanted me as their doctor.

They wanted a male doctor, and they're like, well, he's not available, so I gotta find somebody else. And, you know, a lot of these people are, they'd be great patients. And so I opened back up and now we kind of have it as, you know, you pick your doctor. The other, I think the long-term benefit of that is that you want patients to be with who they want to be with, not who you want them to be with.

And that, you know, in the long-term, that's always gonna work out for the best.

But I think it's a, it's awesome that you know that the patients are asking for options and you have provided options. So I think that's great. Yeah.

Sorry. The other thing I didn't mention was we gave, we sent out an email and basically gave all of my patients the option to switch over to her.

So especially a lot of the female patients have chosen to do that throughout time.

Gotcha, gotcha. And in terms of just looking back on that experience, you know, thankfully Dr. Davenport was there, she was wanting to do this. She was like, I wanna get started as soon as possible, but, For people who are not necessarily as lucky or as fortunate, what advice would you have to people who are, uh, looking to hire physicians into their practice in the future?

Well, as far as where to look, as far as I know, I mean, I. You know, uh, residency programs are a great option, like we kind of talked about before, you know, emailing program directors that are local, uh, or even ones that aren't, if you know people that are, you know, maybe from your neck of the woods, but they're doing residency elsewhere in the country, as well as just, you know, hiring a recruiting firm or posting on Indeed.

I mean, those are all kind of the, I think the standard ways of doing it. I'm yet to do that, although, I might be there at some point, and so I'll probably have to learn more about that process. But the, the, the biggest thing I'd say, and this is more so coming from a lot of other people I know who own businesses, is it has to be a good culture fit.

And I think now more than ever in medicine with it being so politicized and divisive post covid, you really wanna make sure that this is somebody that you can work with long term. So instead of just looking at. You know, kind of what do they look like on paper? Is this somebody you wanna spend time with and that you can work with easily?

Absolutely. And I think that that is such a powerful statement. It might be a general statement, but it is very powerful because culture speaks to so many things. You know, how do you cover call, how do you take care of each other's patients? How do you, you know, the culture of the office is a uniform culture necess, like some people might argue that, but for me it's like, That's the clinic where there's a lot of time with patients, or that's the clinic where it's relationship based medicine, not transactional based medicine like you put in your video.

But I think that, you know, the clinic being uniform really helps also build the word of mouth for the culture that you're bringing to the community. So I think that's, that's really important.

Yeah. And I, I can say that I know at least a handful of fee-for-service docs that have left their practices because they had no choice over the staff that was hired.

And the staff just destroyed the clinic. Absolutely. I, I think we can all think of, uh, you know, people who we've worked with in our training up until now that it's just like, oh my gosh, like I am so glad to be working with another person rather than that person. Oh my gosh. Yeah. Like for me it was somebody, one of my MAs at my fee for service.

She's like, you know, I can set this stuff up for you. I'm like, well, I was not used to having anyone set up my procedures for me. So it's like, you know, things like that where if you are in one culture, there is a a way to think about could it be done differently? And then those are the types of questions also to ask, you know, if there's a A D P C practice that you're looking to join or you're interested in joining, you know, ask about like, How do you guys do specific things like how do you guys cover each other's call?

Like, you know what, what happens if in this situation or that situation? Those are ways to learn about the culture. If you're looking to, to join. For you, you guys have, Mia. Is, is Mia your only staff member in addition to the two of you?

It's Mia and it's me when she's on vacation.

Love it. Love it. So let me ask you, how did you find Mia and what role does she serve at Paradox Health?

So Mia is my good friend's daughter, and, uh, basically I was kind of having a, a nervous breakdown during Covid at one point because I was just, it wasn't so much the volume of work or the time, but just the amount of phone calls I had to field every day was just driving me insane. And so I was, I was actually at the gym on a Sunday and Mia had just finished a phlebotomy course, uh, maybe like two months before.

And she had actually asked me like, are you looking for anybody you know to work at the clinic? And I was like, no, not really. But that was before I got really busy. And so it was Sunday, you know, we're at the gym, her dad's there, her whole family's there. And I was like, I just kind of had this epiphany of like, I.

If she comes to work with me tomorrow, I'm gonna survive. And so I was like, can you come to work with me tomorrow? And she didn't have a job at the time, or she did, but it was, uh, I think she was, she was like waitressing at night or something, and she was like, oh my gosh. Yeah, I would love to. So love that.

And, and from there, I, I kind of just looked at it as like a temporary thing. But then we got so busy and I got so many new patients, I was like, If you wanna keep working here, I, I still need you. You know? And so it was really, I've been really fortunate, really kind of blessed that I haven't had to do a whole lot of interviewing and the people have just kind of fallen in my lap.

I actually did interview one ma for the position. She had lost her job because she wasn't getting the covid shot. She was really experienced. She was like 20, 30 year ma really good. I made her draw my blood on the spot and she was like really nervous, but she did it perfect and she ended up saying no.

She's like, no, I couldn't pay her enough. It was kind of a long story short. So anyways, uh, I hired Mia and that's where we're at. And she does everything. She answers the phone, she draws blood, she does vitals. She gives shots.

Very cool. And in terms of with you having Dr. Davenport, with you, having Mia and you having, you know, not the crazy of the pandemic happening right now, like it was.

Back in 2020. I wanna ask you, what has D P C allowed you to do differently? Like, clearly talked about Lipidology, but what has D P C allowed you to do differently, whether it be your professional practice or your personal life? Everything.

Do you wanna have a whole nother podcast just on that? I like Josh Umbers and statements.

I know if you're familiar with this, but you know, I can see fewer patients and spend more time with them. And spend more time with my family and take more vacation and make more money, you know, and be happier. All of the things, you know, one, I think one of the coolest things about being a DPC doc is that you get to block off your schedule.

You know, if you have something going on, you just say, you know what? I have something I need to do. That time is blocked off. I can see patients, you know, for the rest of the day. And we don't have so many patients that that's actually a problem. You know, you're not seeing 20 people a day, and so you're not saying no to 10 people, you're saying no to like two people, three people, and you've got plenty of other openings, the second half the day and the day after and the day after.

And so I think, yeah, I read a, I read a book recently called The Ruthless Elimination of Hurry, and I think one of the coolest things that D P C allows you to do is to not be hurried. Hurry really is kind of, to me like the root cause of all evil. Whenever we're hurried, we're not spending enough time with our patients.

Whenever we're hurried, we're short with our spouse. Whenever we're hurried, we're stressed out. And so if you can eliminate that, it really just makes a world of difference and, and I think DPC is the only tool that allows docs to do that. I love that. So let me ask you, in closing, when you think about the future, is anything coming down the pipeline for Paradox Health?

No. No. Actually, I didn't mention this to you before I looked at buying a building. I. Then I found out what the property taxes were and I was like, well, I guess I'm never doing that. So that that was gonna be a big change. I was really thinking about that and I, I think that that might actually be part of like a D P C education that would be useful for people because it's such a, the world of commercial real estate, so different than residential.

So no, for the foreseeable future, we're just gonna be probably in this office, we could probably take on another doc. But we kind of need, well, we would like Dr. Davenport to be a little bit more full before we kind of pull that lever, you know? But I think that that's probably the next step would be to find a family practice stock, somebody who can see kids, and uh, and go from there.

For sure. And Bill, I'll take this part up, but did you wanna mention the transition from lab to lab?

Oh yeah, sure. So one other thing that's not like super interesting but really important is we're switching from Quest to LabCorp. Quest has been really great and I'm like, we're in general, we're pretty happy with their labs and what they offer, but they increase their prices every year.

Uh, so they have like a 7% I wanna say. Inflation rate that they just add on to your prices every single year. And so it's gotten to the point where some of the labs are just kind of ridiculous. And my standard panel I order on people now is close to like $180 and I'd really like to lower the cost of that.

So you know, we're gonna do kind of a, a legacy price increase. So some people that came in early to the clinic, Are in like a lower price tier than what our current prices are. So we're probably gonna try and catch those people up to current pricing. But then we're also introducing the switch from Quest to LabCorp, which will in the end, if you get your blood drawn with us just once a year, we'll end up saving you money in the long run.

So, You know, even though your monthly membership fee might go up slightly, if you get your labs drawn with us once a year, you're still saving money out of the whole deal. So I really like the idea of just looking wherever you can to save money on overhead and save money on cost for patients. I think I.

A lot of people get a little bit too lazy and complacent about their practice and stop looking for savings for patients, and we should just always kind of be, be looking for that. Kind of similar to how, you know, Costco hasn't raised the price of their hotdog. They, they started their own hotdog factories.

I love that. That's the understandable. 'cause I can totally relate, like we've been, you know, price club members since 1984, so Amen. Like everyone can understand that. Thank you so much Dr. Hellman for joining us today. Yeah. Thanks for having me. It's been, it's been a lot of fun.

Next week, look forward to hearing from Dr. Remi Kaur of Brooklyn Dermatology in Brooklyn, New York. If you've enjoyed the podcast and you haven't yet done so, subscribe today and share the episode with a physician you may know who needs to hear about D P C. Leave a five star review on Apple Podcasts and on Spotify now as well as it helps others to find all these D P C stories.

Lastly, be sure to follow us on social media if you're wanting to continue learning more about D. B C. In the meantime, check out DPC Until next week, this is Mariel conception.

*Transcript generated by AI so please forgive errors.


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